Provider Demographics
NPI:1497791677
Name:RANKIN, BRADLEY J (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:RANKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:ID
Mailing Address - Zip Code:83420-0400
Mailing Address - Country:US
Mailing Address - Phone:208-652-2225
Mailing Address - Fax:208-652-2226
Practice Address - Street 1:608 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420
Practice Address - Country:US
Practice Address - Phone:208-652-2225
Practice Address - Fax:208-652-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor